Mental Hygiene and Disability in the Zionist ProjectSandy SufianE-mail: sufians@uic.edu

Introduction: The Place of Disability in the Zionist project

Zionism — a Jewish nationalist movement that sought to create a homeland in historic Palestine — tried to change or rehabilitate the Jewish people from their seemingly disabled state in the Diaspora to a new healthy and "normal" nation in Palestine.1 Given Zionism's emphasis upon redeeming the pathological state of Diaspora Jews, the concept of disability figures as a prominent cultural signifier that underscores many facets of the Zionist nationalist project.2 Consideration of mental and physical diseases did not remain at the level of ideology alone; such consideration was also manifested in immigration policy and medical treatment. Although Zionist leaders and physicians of the period mostly used the word "disease," [machalah] when describing ailments of a physical or mental nature, in essence, they were referring to what scholars today broadly describe as "disability," especially in their references to the social, political and economic ramifications of diseases. As such, I use the term "disability" when signaling the Zionist conceptual reference to disease and its socio-economic valences.

Zionist immigration to Palestine began during the late Ottoman period, but it was under British rule (Mandate period, 1918-1947) that the issue of disability took on particular relevance. This article, therefore, focuses on the British Mandate period of Palestine, a time when not only the Zionist movement had already attained a British promise to facilitate the "establishment of a Jewish national home" under the Balfour Declaration (1917) but also when Jewish immigration was increasingly restricted due to ensuing Arab-Jewish political tensions.

Before and during the Mandate period, Zionist ideologues believed that changing the mental state of the Jewish people — from one steeped in Diasporic oppression to one of promised political and emotional liberation in Palestine — was of utmost importance to building a "normalized" nation. Indeed, collective mental disability is a powerful theme that runs throughout Zionist ideological formations and medical discourse. Reflecting this emphasis — and because I have reviewed the topic of physical disease elsewhere3 — this article directs its attention to mental illness as both a signifier and an object of practical policy. Operating within the British Mandatory Government's overarching system with its increasingly strict immigration controls, Zionist leaders and doctors encouraged selective immigration policies, repatriation to Europe or institutionalization of the mentally ill in order to contain and manage what they saw as a serious challenge to the achievement of an ideal society made up of dedicated, resilient, unencumbered "new Jews" in Palestine. In so doing, they prioritized access to the fledgling Jewish homeland to able-bodied individuals, despite a broader promise that Zionism would build a homeland for all Jews. In general, Zionist doctors did not seem to recognize the tension between an exclusionary immigration policy and larger Zionist ideological claims about Zionism's potential to heal all Jewish people in that land. Thus, I argue that disability operated on two, perhaps paradoxical, tiers: one of collective disability able to undergo a curative transformation, and one of individual pathology deemed as incapable of changing and therefore lacking the potential of ever becoming the autonomous ideal.

Jews in Need of Healing: Disability as Signifier

Having its roots in mid-nineteenth century Eastern and Western Europe, Zionism was a response to the strong anti-Semitism that Jews faced in the Diaspora. One of the main goals of Zionism was to "cure" Jews and improve their lot, physically, mentally, socially, economically and politically. In addition to finding a political answer to Jewish oppression, the Zionist movement tried to transform the socio-economic profile of the Jews and their physical and psychological status.4

Although there were many strands within Zionism, the majority of those active in the movement felt that solving the "Jewish problem" in Europe required securing Jewish autonomy in Palestine/the Holy Land. Autonomy, they argued, would "normalize" the Jewish nation amongst a community of nations. This hopeful status stood in contradistinction to the "abnormal," marginalized status they possessed in Europe. Scholars Reinharz and Shapira have observed:

The associated understanding [of normalization], either explicit or implicit, was that the Jewish people, in its present situation, suffered from anomaly at best — and at worst from a condition that was altogether pathological.... It ultimately extended to include attributes of mentality, namely emotional characteristics and psychological dispositions purportedly common among Jews as individuals and in Jewish society as a whole.5

Framing the Jewish problem as one about normalcy created the issue of difference and disability by inferring the modern idea of a deviation from the norm.6

Debates about the physical and mental quality of Jews in the Diaspora as well as its transformative, ideal Zionist counterpart were deeply influenced by late nineteenth century European medical discourses of social Darwinism, eugenics, degeneration, deviance and racial hygiene.7 Jewish racial science developed within the academic study of Judaism, the Wissenschaft des Judentums. Jewish doctors and scientists in the Diaspora used this research for both internal (Jewish) and external (Gentile) consumption to refute common anti-Semitic claims.8 As Raphael Falk has argued:

Zionists claimed that Jews maintained their ancient distinct 'racial' identity, and that their regrouping as a nation in their homeland would have profound eugenic consequences, primarily halting the degeneration they fell prey to because of the conditions imposed on them in the past.9

As such, Zionist ideas about ideal Jews were tied up with the same developments that similarly influenced ideas about individuals with disabilities during the nineteenth and twentieth centuries.

The idea of "real" Diaspora Jews in Zionist discourse — thought to be sly and degenerate due to their oppressive state of exile in Europe — was based in anti-Semitic stereotypes of Jews as a morally, psychologically and physically debased race. Anti-Semites used scientific arguments to show that Jews were a "disabled" group: they were a "hybrid race [therefore not pure], they have no genius, they are color blind, of short stature, they produce an out of proportion of idiots … ."10 Anti-Semites argued that Jews, being a largely urban race, had no roots in the land. Their economic profile made them subsequently shamed and ashamed and they were destined to remain that way; their status was unchangeable.11 In this rhetoric, the conception of the Jews' physically and mentally afflicted, individual bodies was symbolic of national, moral disorder.

Most Zionist thinkers did not fundamentally contest the description of this anti-Semitic sentiment. For both anti-Semites and many Zionists, the degenerate image applied to all Jews; even many Jewish racial scientists elided internal Jewish differences (by country, language, occupation) and created a racial typology.12 Zionist racial scientists and nationalist thinkers, like Arthur Ruppin (head of the Settlement Office in Palestine of the Zionist Organization), Elias Auerbach, Ignaz Zollschan and others, responded to anti-Semitic perceptions by arguing that there was a potential for cure for their collective state of being; that Jewish characteristics were not permanently inscribed or irreversible.13 For Zionists like A.D. Gordon, such debased traits could be altered through relocation to Palestine and through physical labor and hygiene.14 Some Zionist thinkers even viewed anti-Semitism as a disease that could not be reformed, providing yet another reason for Jewish transplantation to a new territory. Relocation would lead to national renaissance, restoring Jewish dignity and Jewish physicality.

The Zionist impulse for national transformation was European in its origin. Many nationalist movements in the late nineteenth and early twentieth centuries envisioned self-transformation and societal reformation in order to reach the ideal of racial perfection.15 Recreating the Jew and the Jewish people also had its roots in the Haskala (Jewish Enlightenment) movement (late 18th-19th c). Most Enlightenment Jews in Europe tried to fortify secular education, encourage entry into other occupations, and stressed Bible study; all endeavors of the mind.16 Zionism's innovation with regard to these tendencies lay in the idea of resettlement to Palestine and consequent improvement of both the individual and nation.

Healing the Diaspora Jew in Zionist discourse required a representational and physical inversion whereby a new, Hebrew man (perceived as strictly male) would be born, healthy in body and mind: muscular, strong, virile, proud, and productive. Much like the anti-Semitic claim about the Jew's individual pathology as a symbol of national disorder, in Zionist ideology, creating an individual, new Jewish body and mind signified creating a new, healthy Jewish nation.17 The vision of a new, Hebrew man is widely attributed to Max Nordau (1849-1923), one of Theodore Herzl's (the father of political Zionism) closest associates and a neurologist by profession. In 1898, Nordau called for the reformation of Jewish bodies through the creation of a nation of "muscle Jews." Reflecting the prevailing notion that physiological and psychological conditions were interconnected, Nordau asserted that Diaspora Jews could overcome their hereditary nervous state by becoming physically and athletically fit.18 Nordau's views greatly impacted subsequent Labor Zionist (the dominant strand of Zionist thinking) efforts to reform the Jewish body.19

Ideas of rehabilitating the Jew formed the basis of Zionist public health programs in Palestine, including those of mental hygiene. Hadassah Medical Organization (one of the major actors in public health and clinical services) stated its ideology as "the promotion of the physical health of the Jewish population of Palestine as a vital factor in the national renaissance."20 Public health programs were seen as central to curing the Jews of their assumed collective pathology. These programs sought to prevent infectious disease morbidity, address psychological stresses, and promote physical exercise and agricultural labor. As one member of the Social Service Department of the Vaad Leumi (General Council) wrote of its mission in 1936:

The life of the Jewish people in Palestine is to be shaped by … . redemption of the soil through united communal effort, and liberation of the people through mutual help in the communal striving for the realization of the ideal.21

Mental Illness in Zionist Medical Discourse

Like the member of the Social Service Department, the goal to "normalize" the mind, body and spirit to find the Jews' place among the nations of the world permeated experts' discussions about the mentally ill in the Yishuv (Jewish community in Palestine). Despite Zionism's purported ability to heal, the existence of individuals with mental illnesses was seen as a thorn that would impede the cultural and spiritual transformation of the Jewish community in Palestine.

Zionist physicians and social workers raised the topic of mental illness most acutely in the 1930s. Several changing conditions in the Yishuv signaled this debate: increased urbanization in Palestine; a worldwide economic recession that affected Palestine; increased anti-Semitism in Europe and the rise of Hitler which brought more Jewish immigrants to Palestine; and heightened tensions with the Palestinian Arab national movement.22 Medical debate about mental illness reached rigorous levels, particularly with the deluge of Central European Jewish physician immigrants in 1933 that brought specialists in neurology and psychiatry. 23 Whereas there were only three neurologists in 1932, 64 practiced in 1942, mostly in the main cities. A few doctors performed psychoanalysis but they were unenthusiastically received by mental health professionals already in Palestine.24

Statistics as a Guide to Legitimacy

Mills' Census of Palestine 1931 was the first governmental attempt to document the rates of "infirmities" in Mandatory Palestine.25 Eric Mills, the Assistant Chief Secretary and Superintendent of Census (a government official), stated that while the statistics overall were unreliable, the government felt that the Census of Palestine would give an indication of the relative importance of various "social evils," i.e. disease, in order to prioritize public health programs and funding in the country.26 The Census included data on insanity ("in an active form as opposed to idiocy or feeble-mindedness"), blindness in one eye, total blindness, total deafness, and deaf-mutism. Assessors noted whether or not the impairment occurred from birth.27 Data was mostly culled from a census of the "insane" in public and private hospitals and was admittedly not inclusive of all cases in Palestine.

Despite their presentation as objective diagnoses, Mills and his consultants acknowledged that determining insanity, blindness or deafness was subject to the opinion of the surveyor, often not well-versed in medical diagnosis or even well-educated. As such, diagnoses were variable or sometimes in error. Dr. J. Hermann's commentary (a Jewish doctor who served as one of Mills' consultants/commentors), distinguished the medical understanding of insanity and the problematic ways in which it was diagnosed for the Census. His comments give contemporary readers a sense of what was meant by "insanity" in Palestine during this time:

The definition 'insanity in an active form as opposed to idiocy or feeble-mindedness' cannot be maintained. In my opinion, one of the radical mistakes which permeates statistics is the constant attempt of the compiler to distinguish between these two forms, although, from the clinical point of view 'idiocy or feeble-mindedness' is quite capable of producing a condition of violent excitement due in part, directly to this disease, in part, to combination with other common mental disease (Hebephrenia) etc.' On the other hand, laymen, lacking the knowledge which enables the alienist to deny an essential distinction between these forms of mental disorder, habitually make the distinction and use different words for the different complaints as if these differed either in kind or in perceptible degree. In nosology there is no essential difference, but in ordinary life, plain men detect some difference which is usually determined by degrees in the violence of emotional excitement. It may be presumed, therefore, that the returns of insanity at the census are of persons who display the most violent forms of emotional excitement and not of merely passive subnormal victims of mental instability.28

Mills' text considered the variable presentation of mental illness

In the case of mental disorder, there is no clear unmistakable division between sanity and insanity. Many persons whose mental disorders may be periodic, or whose hallucinations and loss of judgment and self-control may not be easily apparent, might be regarded by some observers as sane and by others as insane … .imbecility is usually a congenital defect … [and] the weak-minded are often also deaf and dumb."29

Mills and Dr. Hermann further commented that prevalence numbers [65/100,000 for Muslims, 109/100,000 for Christian Arabs and 141/100,000 for Jews] under-represented the true number of cases because of a long-held stigma of mental illness that tended to discourage families from reporting family members with such infirmities, due to shame.30 As Mills explained, "there may be a greater reluctance on the part of Jewish householders to declare the insanity of members of their households, particularly since under present conditions in Palestine it is impossible to provide facilities for the treatment and skilled care for more than a very limited number of mental patients."31 The shortage of facilities will be taken up later in this article.

A subsequent census of the Jewish mentally ill in 1936, performed by prolific Zionist neurologist Lipman Halpern, gave Zionist medical professionals and policymakers a descriptive profile that could explain the contours of the alleged national, racial traits of the Jews and a pathway to an ideal society. This latter census compared its findings to the Mills census and elaborated on the reasons for its results. Dr. Lipman Halpern, a Berlin doctor who founded the Department of Neurology of the Rothschild-Hadassah University Hospital in Jerusalem and one of the most prolific writers on the subject during this time, identified a total of 726 mentally ill Jewish patients in Palestine in 1936, as opposed to 249 Jews in the 1931 Mills' census. This increase was explained, in part, by growth in the Jewish population. Halpern noted the prevalence rate of mental illness among Jews as 194 per 100,000.

Halpern's diagnostic categories on mental illness for Palestine were more detailed than the Mills' census. Jewish patients hospitalized fell under eleven diagnostic categories: schizophrenia, manic depression and paranoia were predominant, accounting for more than three-fourths of the caseload in 1936 and 1941.32 In addition to giving morbidity rates, data was stratified and discussed along the lines of gender, age and economic impact.33 The youthful profile of the mentally ill in the Yishuv reflected the young immigrant population. People ages 15-30 were considered the most predisposed to mental illness.34 Halpern did not enumerate ages over 60 because their population number was a minority in Zionist immigration and their use in the labor market was not considered "vital."35

Syphilis, encephalitis, epilepsy and cognitive impairments like "idiocy" and "imbecility" — especially among youth — were of particular concern for their economic and cultural impact. Jewish social work figures, like Chaim Eitan, and professionals like Halpern were concerned about the inability of young immigrants with mental illness to work. Since productive work on the land (i.e. farming) was considered the ideal way to devote oneself to the Zionist movement, and people ages 15-30 were considered the most desirable workers, inability to do such labor was considered a serious problem.36

The concept of independence, both individual and collective, stood alongside the idea of productive work in Zionism. This movement tried to break away from earlier conceptions of the Old Yishuv, the religious Jewish community which was seen as entirely dependent for its survival upon charity from abroad. Self-help and independence were therefore key components of the Zionist endeavor; pioneers in the New Yishuv would be self-sustaining and proud. Likely understanding the tension between collective transformation, independence and individual illness, while highlighting the elements of interdependence and community in Zionism, Henrietta Szold, a leader in social and medical work in Palestine, said:

Unless we devote part of our forces, spiritual and economic to the fulfillment of our social duty towards children and the aged, the sick and the poor, our claim to be building the country completely and symmetrically is not justified.37

Besides quantifying the extent of mental illness in the Yishuv, the Halpern's census was used for comparative ends. Comparative psychiatry, so it was called, had as its object "the study of the psychopathologic peculiarities of different peoples and races …."38 Scholar Raphael Falk notes that nationalist movements of this period were just as concerned with the identification of their specific characteristics as with the conditions that brought them.39 Comparative statistics brought the alleged national and racial characteristics into stark relief and enabled Zionist scientists to analyze questions about the inborn/acquired qualities of race and issues of national legitimacy and normalcy: if national characteristics were inherently biological, were they primarily inborn or acquired? Were Jews a legitimate nation? Could they become a normal nation?

Looking for answers, Halpern noted the ethnic makeup of patients. He elucidated ethnic differences in morbidity since diseases were often seen as a product of a eugenic, racial hierarchy during this time.40 His details about the characteristics of different types of Jews (Ashkenazi/Sephardi, age differences, gender differences, etc.) was consistent with larger trends in physical anthropology that tried to document extents of racial purity or diversity and differences between nations.41

In one comparative exercise, Halpern looked at differences within the Jewish patient population. Eighty-five percent of all mental illness was among Ashkenazi Jews while Sephardic and other "oriental" Jewish communities (those of Middle Eastern origin) each exhibited percentages less than 10%.42 Halpern believed that different rates of morbidity among Jews could be attributed to fixed, racial qualities and historical experiences that had made their stamp on each respective group.

Jewish patients in general, both in Palestine and elsewhere, are distinguished by a certain feeling of self pity. Some of them, especially among the older generation of Ashkenazim, combine this feeling with a tendency to 'philosophize' about their complaints. … .For many of these people, including some of the younger generation, their complaints become their main interest in life …

Contrasting a supposed Ashkenazi resignation, Halpern noted that Oriental Jews tended to be theatrical about their symptoms:

Many of these comparatively primitive people share certain medical superstitions with the Arabs. Burning of the skull, forehead or between the eyebrows with a hot iron is not uncommonly practiced in Palestine by both Jews and Arabs as a means of curing psychoses. They similarly burn the afflicted limbs in cases of paralysis. The Prophet Elijah enjoys considerable popularity among the Jews as the healer of psychic diseases, as does St. John among the Christian Arabs. It is the practice, among the indigenous Jewish population, to take people suffering from psychoses — especially when medical assistance has proved ineffective — to Elijah's Cave on Mount Carmel. There the sufferers are left for the night, sometimes bound hand and foot, while their relatives offer up appropriate prayers for their recovery.43

Mental illness statistics were also used to confirm the dominant notion that prevalence of mental illness was associated with the level of industrialization of a population. Mental health professionals of the period understood mental illness as a "disease of modern civilization," an outcome of modern life. As Mills noted in his Census:

The noise of industrial countries, the general struggle not only for a better condition of life but for bare existence all play their parts in destroying the balance of the nervous and hence of the mental system. The individual organism known as a person is continually adjusting itself to these conditions building up defences [sic] most appropriate to the forms of the attack of its harmony. On occasion, this adjustment, seldom perfect, is inadequate and the defences break down leaving the organism helpless against the assaults, which disturb the equipoise of its natural existence.44

Dr. Hermann added a eugenic explanation: although the connection between psychoses and progressive civilization certainly existed, "this connection is frequently shown only indirectly through injury to the embryo … no one becomes insane … without a predisposition to madness." Increasing civilization, with its elevated number of nervous disorders, indirectly influenced "the deterioration of the hereditary proportion in the next generation."45

Comparisons between the mental state of Jews in Palestine to those of other industrialized nations and to other communities within Palestine operated under the "modern civilization" paradigm. The methods of inter-nation comparisons, however, were often not valid; numbers between countries were compared for different years and therefore didn't account for population growth, mortality or other demographic changes.46 Despite these discrepancies, they comparisons were made and discussed.

An implied objective of such comparisons was that it measured how "normal" or "abnormal" Jews had become (or could become in Palestine), how adaptive Jews were to modernization, and the extent to which the Zionist project had exhibited its social, curative properties.47 Assessing the level of "normality" of the Jewish people addressed anti-Semitic claims of the immutability of Jewish nervous, weak characteristics — statistics showed instead that Jews in Palestine had a lower rate of mental illness and therefore had changed their collective mental disposition through the instrument of Zionism. Indeed, in Halpern's study, Jews in Palestine measured "favorably" in terms of mental health as compared, however crudely, to those in Jews and Gentiles in Europe. Mills' study complied, signaling to the author that:

conditions of life in Palestine give to Jews a greater sense of personal harmony than has been their experience elsewhere. Mental equipoise in their case may be less liable to disturbance despite the undoubted difficulties arising from the difference of climate as between Palestine and their countries of origin, and the drastic changes of their occupational and social lives.48

Collective mental characteristics were deemed environmental and mutable. Jews could become normalized; they were not destined to remain in their Diasporic, pathological state.

Halpern's statistics showed, however, that Jews still exhibited a higher rate of mental illness than other populations in Palestine for similar years. Arab/Jewish comparisons were likely done in order to solidify the perceived, more advanced, modern state of the Jews and thus their worthiness in attaining a national homeland.49 A higher rate of mental illness amongst Jews in relation to Arabs in Palestine led psychiatrists in the Yishuv to ask the question — why? This question took on particular relevance in light of increasing political tensions in the country. The answer touched upon national understandings of pathology and social sophistication — an analysis of aggregate characteristics — rather than upon an individualized analysis of disease. Halpern believed that the Jews' higher prevalence should come as no surprise: "an increase of mental illness depends upon the advancement and development of the civilization owing to the changes in the ways of life, the traits of the body and mind, and the social and spiritual complications that are involved in it. This suggestion carries weight not only for Western nations but also Eastern nations."50 Although Jews and Arabs both belonged to the Semitic race, Halpern explained that Arabs had preserved "the traits and customs of oriental people" while most Jews in Palestine returned to the land from western countries, bringing with them the influence of West European, industrialized culture.51 Furthermore, immigrant populations, like the Jews to Palestine, were particularly at risk for exposures like dislocation; the vast change in lifestyle itself in Palestine could excite certain predispositions and put a heavy "psychic burden" upon the newcomer.52 Halpern cited psychotic outbreaks during the first year of residence in Palestine as common amongst Jews. He referred to Dr. Blumenthal's work that showed a declining rate of psychoses among immigrants the longer they settled in Palestine.53

Halpern also tried to explicate the distribution of mental illness in Palestine by religion. He framed the issue as one about religious history and national development. He explained that Christians and Muslims were counted as part of one Arab nation even though they had separate religions. Their differential religious histories partially accounted for differences in mental illness prevalence between the two groups: Christians ruled the Western part of the Holy Land and produced a huge revolution in all aspects of life. Christian Arabs gradually crystallized a particular sociological profile: they are mainly urban, owners of industry, national intellectuals, officials — all positions emblematic of civilization. For Halpern, this advancement in turn elevated their rates of mental illness; they were, to Halpern, civilized Arabs. The closer a culture was to modernity, the more mental health issues and nervous diseases its citizens would exhibit. For Halpern, Christian Arabs' higher position on the ladder of civilization helped explain the differential rates of mental illness between Christian and Muslim Arabs.54

Despite their varied backgrounds and countries of origin, Jews were similarly urban-based. Halpern noted that once having returned to the land of Israel, Jews ceaselessly tried to strike roots in the motherland and endured harsh conditions. In addition to these trials (which could cause mental disturbances), Halpern believed Jews exhibited greater concern for the fate of their mentally ill; they more openly and actively treated their mentally ill patients. According to Halpern, "members of lower cultures" did not exhibit this concern to the same extent. Thus, in comparison to other "civilized" cultures, cases of mental illness among Jews in Palestine were low. These statistics proved to Halpern and others that collectively, Jews were civilized, cared for their ill, and had mutable characteristics that could be cured. These characteristics were all desired qualities of a legitimate nation.

Statistics were used to profile the making of that legitimate nation and to explain and compare differences with other groups. Statistics proved to professionals like Halpern that Jews were a civilized nation and that, despite the stresses that immigration posed, Zionism ultimately had a therapeutic effect.

Immigration, Treatment and Repatriation of the Physically and Mental Ill

Exclusionary Immigration

How did the previous discussion about mental illness translate into policy? According to Halpern, his results reflected the fact that the Yishuv was a community of immigrants. "The low frequency among Palestinian Jews … .is largely due to the selection of immigrants and the prevention of admission of persons with mental disease."55 Theoretical discussions about the rates of Jewish mental illness, which situated prevalence as a function of modernity and centered on questions of the collective ability to change, thus confronted practical measures which excluded mentally and physically ill individuals from entering Palestine. Such an approach posed a tension between Zionist ideology and practice because it implicitly challenged the inherent power of Zionism to cure and transform everyone. But during the Mandate period, practical considerations in this area took precedence. Elements of ableism and normalcy in Zionism were privileged and translated into policy; attainment of the ideal underscored immigration policy. Only those Jews without mental or chronic physical illness were intentionally admitted into Palestine so as to, principally, maximize the labor of the fledging proto-state and through labor, enable spiritual and physical renewal.56

Excluding immigrants because of mental or physical illness was not a new measure in the early to mid-twentieth century context. Influenced by eugenic beliefs, most governments around the world before and during the interwar period restricted immigration based upon medical un-fitness.57 The British Mandatory Government (BMG)'s Immigration Ordinance of 1925 adopted a policy similar to those of other countries. Contagious diseases (syphilis, leprosy, TB), epilepsy, lunacy, idiocy or anyone deemed mentally deficient was considered excludable.58

The Zionist Organization's policies were situated within the umbrella of BMG's rules. Although the BMG consulted with the Zionist Organization on the Ordinance's content, it was the Zionist Organization (ZO), and later the Jewish Agency (JA), that implemented these rules for the Jewish population. The ZO and JA were charged with making decisions, for example, about who exactly was considered mentally impaired. The Zionist immigration process occurred in the following way: every six months, the Mandatory Government would give the ZO a labor schedule that would detail the number of immigration certificates allotted. This labor schedule was accompanied by directions about the labor skills of the immigrants, their age and the ratio of the sexes. As the Mandate proceeded, the Government sometimes even dictated the specific countries to which certificates would go.

The Government issued immigration permits to Jews based on several fixed categories: Category A consisted of persons of independent means (capitalists whose number was unlimited); Category B was comprised of students and persons of religious occupations whose maintenance was assured; Category C covered people with a definite prospect for employment (laborers whose number depended upon the "economic absorptive capacity" of the land and therefore continually changed); and Category D was made up of dependents (women and children) or permanent residents. The Mandatory Government controlled Categories A, B and D but granted partial authority to the Zionist Organization for Category C in exchange for a promise by the movement to guarantee the maintenance of such immigrants in their first year of residence. 59

Given these stipulations, the Zionist movement "adopted a policy that championed immigration of only the Zionist elements who were healthy in body and soul and capable of assisting in the building of a future Jewish State."60 This meant hindering others deemed less desirable by eugenic standards, like the mentally ill, from entering Palestine. Their degenerate, ostensibly immutable, state could undermine the attainment of legitimate nationhood. Many Zionist settlers thought that by adopting eugenic doctrines, they were saving the Jews from the deterioration of Diaspora life and building a new society based on modern science.61 One social worker of the period proudly acknowledged the prioritization of healthy types, despite a belief in the collective disability of Diaspora Jewry. The Jewish Agency, he wrote, regulated the stream of immigration so as "to encourage the entry of socially productive elements into the country."62

Quality was considered just as important, if not more important, than quantity.63 This kind of debate had its roots in earlier Zionist discussions weighing the benefits of uncontrolled immigration. Some activists believed in unrestrained immigration while others felt that such a policy would endanger the Zionist project. Initially centered around class issues and political leanings, discussions then began to more prominently include medical issues.64 By 1919, Arthur Ruppin, head of the Palestine Office in Jaffa, raised concerns over quality vs. quantity. Ruppin argued that past Zionist immigration policies during the late Ottoman period, where a "cult of numbers" existed, allowed leaders to overlook physical characteristics; the "old, [and] sick" and those with an "anti-social character" were let in. Even though this "automatic selection" did not have dire consequences on the social profile of the Yishuv by the end of WWI, the policy could not continue. "Critical sifting" needed to occur during the Mandate period. In "Selection of the Fittest," Ruppin recommended very specific measures to "raise the level" of the immigrant:

We shall have to limit ourselves, in regard to the physical equipment of immigrants, to rejecting those individuals who are dangerous by virtue of some infectious disease (syphilis, advanced tuberculosis, etc.) or are likely to become public charges (the mentally deranged, epileptics, all those who are prevented by sickness from making a living). The elimination of such persons should be taken care of by the doctors of the Palestine Immigration Offices in the ports of sailing; but a second examination should take place in Palestine in the ports of arrival.65

Ruppin added anti-social types to the exclusion list in a subsequent section of his article. Leniency on the recommended policies could only hurt the Yishuv, "for the member of the inferior type is like a social ulcer..."66 Dr. Hillel Yofe, prominent physician and founder of the Hebrew Medical Association in Palestine, concurred with Ruppin's ideas.67 In theory, so did Dr. Matmon, writing years later in 1933: "The best material in a nation is that which always marches forward, or more precisely, drags the weaklings behind itself."68

In order to assure healthy bodies and minds and to avoid unnecessary medical and social expenses for Category C immigrants in their first year, the Jewish Agency had organized a selection process already in the 1920s. This system was based on Zionist training camps and on a network of Jewish physicians who did medical inspections in Europe. The process worked to maximize the quality of "human material" coming to Palestine.69 Every immigrant received a health card that detailed the results of medical tests performed at the point of departure. Medical inspection was performed again upon the immigrants' arrival. Immigration certificates were usually given to men between the ages of 18-35 who were capable of doing physical labor or had a specific trade.

Zionist immigration policies mixed with other demographic challenges. First, at every stage of its development, the Zionist movement had the goal of maximizing immigration to its fullest extent. Attracting people in Europe to come to Palestine was no easy task. As a result, the Jewish community in Palestine was relatively small compared to the Arab population. In addition, some immigrants in each wave of immigration (before the rise of Hitler) decided to emigrate to Europe, mostly because they deemed life too hard in Palestine. Retention was a major goal of the Zionist project. Despite this general policy, the movement's leaders frequently debated about the quantity versus quality of immigrants. Second, the British government increasingly limited immigration quotas as the Mandate period proceeded and political conflict intensified. As these quota numbers decreased, the concern of selecting non-disabled people intensified even more. In fact, 1932 was the first time in the history of immigration to Palestine when the supply of immigrants was greater than the number of certificates available. The period when discussions about mental illness and other disabilities gained greater attention, the 1930s, also marked the first time that Palestine became the main destination of Jewish immigration.70

Caring for those who made it through

Despite attempts to limit individuals with disabilities from entering Palestine, some people managed to arrive and pass the medical selection process or their illness manifested itself after immigration. Those with mental illness were among the people featured in Halpern's 1936 census. A general shortage of hospital beds and health care workers, at least until 1933, influenced Zionist leaders' and physicians' strong preferences to limit the immigration of the medical unfit so as not to exacerbate an already troubled health infrastructure.71 A shortage of Jewish mental hospitals in Palestine was especially acute, leading psychiatrists to advise the Zionist leadership against the particular immigration of the chronically mentally ill. Some doctors even took the step of noting in asylum medical records whether the patient had newly arrived in Palestine and how long s/he had lived there.72

Mental facilities in Palestine included the Ezrat Nashim Mental Hospital founded in 1895; the Government Hospital in Bethlehem established in 1922 (the only institution for the Arab population); Jewish public institutions in Jerusalem and Bnei Brak and Neve Shaanan, an asylum in Ramat Gan for "defective children in Jerusalem," (described as totally inadequate), and other private institutions.73 In 1944, Kupat-Holim, the health insurance provider of the Histadrut (the General Federation of Labor) opened up a mental hospital for its members called Gehah for acute cases only. One private psychiatric hospital existed in Haifa, one in Jerusalem and three in Tel Aviv. Giv'at Shaul also had three homes for the mentally ill although these were not under strict medical supervision.74

In the middle to late 1930s, the professional community became more organized, holding conferences and forming specialist associations like the Neurological and Psychiatric Society. By the 1940s, care for the mentally ill had increased substantially and had introduced outpatient care. Kupat Holim (the Histadrut's arm which provides health care services), and Hadassah's hospitals in Jerusalem and Tel Aviv offered out-patient clinics for "nervous diseases" and other mental illnesses. A clinical neurological service at Hadassah in Jerusalem, the only one of its kind in Palestine, was also founded in 1939.75 Ezrat Nashim and the Psychoanalytical Institute of Jerusalem also admitted outpatient cases.76

Political crisis in Europe and in Palestine in the 1940s caused anxiety illnesses in Palestine. Halpern noted in 1944 that refugee immigrants, those escaping Nazi concentration camps, not surprisingly exhibited traumatic neuroses. The air raids on Tel Aviv during WW2 also caused such diagnoses. Still, by 1944, Halpern complained of a lack of psychiatric beds in mental hospitals. Given the rate of mental cases was 200 per 100,000, Halpern argued that one thousand psychiatric beds were still needed for the Jewish population alone.77 Due to a lack of beds, patients were discharged before their treatment was completed in order to make room for others in need. "Unfortunately, there was still a large number of harmless insane persons who are in a deplorable condition and walk the streets of the towns and villages." Melancholia and depression mostly afflicted these wanderers. "Several cases of suicide from depression might have been prevented if hospital facilities had been available."78

Expenditure on caring for Jewish mentally ill patients in 1936 totaled 23,000 Palestinian lira.79 The Yishuv expended over 50,000 Palestinian lira in 1941 to maintain its mental health institutions.80 In addition to addressing ideological concerns about healthy bodies and minds, then, excluding the mentally ill and others was intended to curtail the financial burden that the Yishuv was thought to assume, especially given the very small attention paid by the Mandatory Government to the provision of mental health care.

Sending them back

Eugenic concerns and practical constraints led immigration agencies like the Jewish Agency and the Secretariat for Health Matters of the Jewish National Committee in Israel to recommend repatriation to Europe of those mentally ill people who had slipped through immigration inspection by accident or had become ill after their immigration. According to Shvarts et al, by the end of 1930, hundreds of immigrants with disabilities were returned to their country of origin. One third were diagnosed with nervous or mental diseases.81

Even after Hitler had declared the Law for the Prevention of Offspring with Hereditary Diseases (July 14, 1933), Chaim Yassky (Director of the Hadassah Medical Organization), wrote in the 1937 edition of the Bulletin on Social Welfare in Palestine of the General Council of the Jewish Community, that people with chronic illnesses who didn't have the means to go back to their families in Europe, usually stayed in Palestine, "causing a continual burden on the public and on its social institutions."82 As such, the Social Welfare Department of the Vaad Leumi (the National Council) founded a special fund in 1935 to repatriate the ill to their families abroad and pay the cost, rather than keep them safely away from the precarious developments in Europe. Hitler had not yet invaded Poland, but anti-disability and anti-Jewish policies emanating from Germany certainly could not have signaled patients' safe return for leaders who advocated repatriation. In fact, the fund was established the same year as the 1935 Law for the Protection of the Hereditary Health of the German Nation.

Agencies that contributed to this repatriation fund included the League for Fighting Tuberculosis, the Tel Aviv Municipality, social welfare committees of several moshavot (settlements) and cities, the Society for Aiding the Chronically Ill in Tel Aviv, and two Kupat Holim funds. Yassky reported that by December 1936, the Fund had sent back tens of chronically ill people. This included, but was not limited to, the mentally ill. Yassky supplied a table showing the number of people "helped" and the total monetary amount distributed between 1935-1936. The Fund had given 39 people money and contributed to their ship expenses while it assisted 63 people in reducing their ship expenses only. A total of 226, 210 Palestinian lira was given in aid.83 Yassky noted that in 1937, the demand to use the Fund increased to the point that it couldn't help all those who had requested it:

The experience of the past two years since the fund's establishment, which proves its importance and its benefit, shows that it is necessary to increase its income and the Vaad Leumi now needs to consider ways to find sources to do that.84

As late as August 1939, three months after the MacDonald White Paper which severely limited Jewish immigration to Palestine and one month before Hitler's invasion of Poland,85 the Department of Social Service of the Vaad Leumi revisited the repatriation issue. Item 14 of its report states: "Without a doubt, one of the most acute problems in the social life of the land is the question of caring for the chronically ill, the mentally ill, pulmonary cases and different invalids that are deprived of the ability to work by accidents or continued illness."86 Many of the mentally ill cases, the report read, needed continual hospitalization, so they cost more to treat. Those who are "not absorbed in fitting institutions, who wander outside, who endanger the public's peace … ., greatly ruin the face of the Jewish community in Eretz Israel."87 Repatriation would restore the respect of the Yishuv. Acknowledging that they could not heal these particular Jews, leaders sought to remove them altogether, restore the potential to cure the nation and create the collective ideal.

Thus, despite a concerted attempt to provide treatment for the Jewish mentally ill in Palestine and manage the challenge through asylum, an equal push existed to either prevent the challenge altogether, through stricter selective immigration, or get rid of serious cases through repatriation. Individuals with mental illness could be managed, albeit insufficiently, in Palestine but their potential for cure was deemed improbable; their degenerate state was therefore considered a thorn in the side of the transformative project of Zionism. All of these perspectives and approaches fit into classic eugenic measures of the time. Zionist solutions luckily did not come close to those of the Third Reich's, but managing the Jewish mentally ill in Palestine broadly fit into the eugenic framework of preventing the "problem of disability" through immigration policy or eliminating it by means of asylum or repatriation. These solutions were complicated by a lack of medical facilities, limited funds, the presence of an imperial power, and the internal political conflict continually brewing in the land.

Conclusion

Discussions about medical selection and repatriation more or less dissipated in the wake of WWII, mostly because of the Holocaust and refugee status of those Jews who had survived. With the emergence of the State of Israel, British rules no longer applied. A new mass immigration to Israel, composed of Middle Eastern Jews, in the 1950s, however, raised similar eugenic concerns about the makeup of Israeli citizenry.

Disability as a cultural signifier — a marker of whether or not Jews could constitute a legitimate, normalized nation — permeated discussions of identity both before and after the State of Israel was born. Distinct in many ways from other nationalist movements of the time, Zionism's adherents tried to build a homeland "from scratch" (albeit under the umbrella of an imperial power). They desired to establish their nationalist movement as valid and authentic in the eyes of the international arena. Achieving that homeland was done through transplantation and transformation; Zionism sought to answer and resolve anti-Semitic claims of collective disability in the Diaspora by changing the profile of immigrant Jews in Palestine. Internalizing the basic idea of this collective disability, Zionist thinkers and physicians employed normalcy as their ideal with labor as the primary means to achieve it. Suitability, fitness and character therefore remained powerful notions for acceptance into the new Zionist society and into the world of "normal" nations, even as that society was "in the making."

Disability in the Zionist project was first and foremost ideologically configured as a national problem. Mental illness, in particular, stood at the center of several ironies and fractures in Zionist thinking: it signified modernity (as mental illness allegedly affected modern peoples in greater numbers) and "advanced," nations but was simultaneously indicative of a difficulty to adapt to modernization; it was an excludable category in immigration policy yet its medical treatment was not ignored. The communal ideal to take care of the mentally disabled ironically was used to prove that Jews were more "civilized" than other cultures — even though that level of civilization, in turn, caused more mental illness, which would ultimately undermine claims to normalcy.

Yet curtailing immigration of individuals with disabilities fundamentally debunked the basic promise of Zionism that the Jewish homeland would be open to all Jews. Only healthy Jews who were deemed potentially productive were given entrance to Palestine; these candidates, it was hoped, would assumedly pass on ideal characteristics to future generations. In contrast, individuals with disabilities were seen as impeding the nationalist goal of creating an ideal nation; subsequent actions were taken to alleviate that challenge. Despite selective immigration and repatriation on an individual level, the overarching belief that Zionism had the power to heal, cure and transform (at least in the collective and on the level of the image) was not explicitly questioned or relinquished. Whereas individuals with disabilities were seen as degenerate, exhibiting characteristics that were considered manageable but immutable, Jews as a collective, possessed mutable qualities that invited revitalization and reformation. Claims about the potential to change provided Zionists with the means to prove the ultimate value of Jews as a legitimate nation.

Douglas Baynton's seminal article "Disability and the Justification of Inequality in American History." in Paul Longmore and Lauri Umansky. The New Disability History: American Perspectives (New York: New York University Press, 2001) 52.
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For physical disability, see Sandy Sufian. Healing the Land and the Nation: Malaria and the Zionist project in Palestine, 1920-1947. (Chicago: University of Chicago Press, 2007).
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Efron 127; Raphael Falk. "Zionism and the Biology of the Jews." Science in Context 11(3-4): 1998, 590.
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Efron 127; Mitchell Hart. Social Science and the Politics of Modern Jewish Identity (Stanford: Stanford University Press, 2000); Sander Gilman. "The Jewish Nose: or Are Jews White?" The Other in Jewish Thought and History: Constructions of Jewish Culture and Identity, ed. Laurence J. Silberstein and Robert L. Cohn (New York: New York University Press, 1994) 375.
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David Goldblatt. Is the Jewish Race Pure? An Examination of the Evidence Against and A Statement of Facts in Its Favor (New York: Goldblatt Publishing Co., 1933) 8; Falk 589; Sander Gilman, Difference and Pathology: Stereotypes of Sexuality, Race and Madness (Ithaca: Cornell University Press, 1985), The Jew's Body (New York: Routledge, 1991) 233-236; George Mosse, Confronting the Nation: Jewish and Western Nationalism (Hanover: Brandeis University Press, 1993); Michael Berkowitz, Zionist Culture and West European Jewry (Chapel Hill: University of North Carolina Press, 1993) and Western Jewry and the Zionist project (Cambridge: Cambridge University Press, 1997).
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Richard Cohen. "Urban Visibility and Biblical Visions: Jewish Culture in Western and Central Europe in the Modern Age." in David Biale, ed. Cultures of the Jews: A New History (New York: Schocken Books, 2002) 733, 765-766; David Biale. "A Journey Between Worlds: East European Jewish Culture from the Partitions of Poland to the Holocaust." in Cultures of the Jews 820-834.
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In their basic form, his ideas were replicated by other Zionist parties like the Revisionists and the Religious Zionists. See Biale's discussion 190-191.
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Siddy Wronsky. Social Work and the Jewish Community Idea in Palestine, Third International Conference on Social Work, London, 1936 (Jerusalem: General Council of the Jewish Community of Palestine, Social Service Department) 11; Sufian. Healing the Land.
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The Palestinian Arab nationalist movement doesn't seem to have had the same impulse for curative transformation. By the mid-1930s, the Yishuv's educational and health institutions were relatively established although some gaps in provision still existed.
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Whereas before 1933, the total number of Jewish physicians numbered several hundred, after the physician immigration over two thousand doctors held residence. Dov Neiderland. "Hashpa'a harefuim — ha'olim meGermania 'al hitpatchut harefuah be Eretz Israel (1933-1948)." Cathedra 30 (1983) 111-160.
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As Rolnik explains, psychoanalysts had to adapt their individualist, therapeutic bent and experience to the collectivist, ideological climate of the Yishuv. For reception of Freud, see Eran Rolnik. "Psychoanalysis Moves to Palestine: Immigration, integration and Reception" in Psychoanalysis, Identity and Ideology: Critical Essays on the Israel/Palestine case. John Bunzl and Benjamin Beit-Hallahmi, eds. (Boston: Kluwer Academic Publications, 2002) 141-200, especially 150-151, 153-54, 156-158, 162, 165.
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The percentage of Jews within this bracket with mental illness in 1936 was 32%. Halpern, "Some data" 1216-17; See Dr. Hermann's comments about the need to more strictly control the entry of "mentally disordered immigrants" in Mills, Census 231, 231 fn1, 236-7.
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Mills noted ethnic differences in his 1931 Census both because of eugenic reasons and because the British took care of Arab health issues during the Mandate period while the Jews had relative autonomy over their health affairs.
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Lower rates of mental illness among Muslim Arabs was explained as a product of their rural, agricultural profile, where they lived a "life of tranquility" with none of the disturbing factors present in the life of industrial countries. Mills. Census 230.
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Such political explanations "proven" by health data were common during this time. They were often meant to sway the Mandatory Government into increasing the number of Jewish immigration certificates and in permitting autonomy in certain areas of life in the Yishuv. Sufian. Healing the Land; Halpern, "Some Data" 1221 for more comparative, Arab-Jewish mental health data.
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59% of all psychoses that developed among Jewish immigrants occurred in their first year of residence; 25% occurred in their second year; 19% in the third year and 6% in the fourth year. Halpern, "Neurology and Psychiatry in Palestine." 776.
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These are terms used by Arthur Ruppin. "Selection of the Fittest." Three Decades of Palestine: Speeches and Papers on the Upbuilding of the Jewish National Home (Schocken:Jerusalem, 1936) 69.
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For number of beds in each hospital, see Halpern, "Neurology and Psychiatry" 780; Mills, Census 231, 232 fn1.
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On types of therapy, see Halpern. "Neurology and Psychiatry in Palestine" 778 and Zalashik and Davidovitch. 94, 95.
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By 1944, yearly attendance for Histadrut clinics reached 1400-1800 Jewish patients. Hadassah Hospital in Jerusalem, although it had begun caring for neurological cases in 1926, did not have until out-patient clinic for mental illnesses until 1938. Both Hadassah facilities in 1942 cared for more than 2000 patients, out of a population of 500,000 Jews in Palestine.
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Another 600 beds were needed for the Arab population; but only 569 total beds existed for both populations in 1941 — 82 beds were relegated for the Arab population and 487 beds were for Jews. Halpern, "Neurology and Psychiatry in Palestine" 777.
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Forty percent of all Jewish patients were treated in Jewish hospitals while 14% were treated in British Mandatory Government hospitals. Halpern. "Insanity among the Jews" 2.
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Halpern, "Neurology and Pschiatary in Palestine" 778. For continued concern about institutionalization in 1946, see General Council of the Jewish Community of Palestine, Social Welfare Service of the Jewish Community, February 1946, Jerusalem, pp. 44-46.
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The MacDonald White Paper was issued in May 1939 and responded to the strong objections shown by the Palestinian national movement during the Arab Revolt 1936-1939. It stated that Jewish immigration would be limited to a total 75,000 for the first five years, and then would be contingent upon Arab consent.
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No author. "HaTipul becholim chronim vehacharazat cholim hashuchaie marpe lechul." Item no. 14. Social Welfare in the Jewish Community of Palestine. (Jerusalem: Department for Social Service of the Vaad Leumi, August 1939) 29.
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